Clinical Profile of Pediatric HIV Infection from India^∗

Background

Our aim was to study the clinical profile of pediatric patients admitted with HIV infection.

Methods

The prospective study was conducted from January 2000 to October 2001 at a tertiary care referral teaching hospital in Mumbai, India. Admitted in-patients (aged 1 month to 12 years) detected to be HIV-positive (on triple ELISA test) were enrolled in the study. HIV status of patients <18 months of age was confirmed by DNA-PCR testing. Demographic data, clinical features, investigations and outcome were recorded in a pre-designed proforma.

Results

Fifty HIV-positive children (31 males and 19 females; M:F = 1.6:1) were enrolled. Thirty cases were completely immunized, 9 were partially immunized while 11 were not immunized. Forty-two were perinatally infected, while eight cases were infected via blood transfusion (patients with thalassemia major on chronic transfusion therapy). Clinical features at presentation in 42 symptomatic cases included protein-energy malnutrition (90%), fever >1 month (50%), weight loss >1 month (50%), persistent generalized lymphadenopathy (24%) and skin manifestations (79%). The gastrointestinal (62%) and respiratory (52%) were the most commonly involved organ systems. Opportunistic infections noted included tuberculosis (19 cases), candidiasis (6 cases), Pneumocystis carinii pneumonia (4 cases), herpes zoster (3 cases) and giardiasis (1 case). Six patients died (mortality, 14%).

Conclusions

Perinatal transmission is the most common mode of acquiring HIV in the pediatric age group. Most patients have protein-energy malnutrition. Tuberculosis is common in HIV-infected Indian children. Patients with HIV-encephalopathy have a poor outcome.

Introduction

According to the estimate of the World Health Organization, approximately 2 million children had been infected with human immunodeficiency virus (HIV) by the year 2000 (1). Vertical transmission (mother to child) is the main route by which childhood HIV infection is acquired, the risk of perinatal acquisition being about 25% 1, 2. Perinatal transmission of infection accounts for 80–90% of pediatric HIV disease 1, 2. HIV infection has had an exponential rise in developing countries like India, especially in urban areas 2, 3, 4, 5, 6, 7, 8. The present study aimed to detail the clinical profile of pediatric HIV-infected patients admitted to a tertiary care referral hospital in an urban city of India. Though there exists significant literature on the clinical features of HIV infection in the pediatric age group from the rest of the world, there have been few studies from India 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18. Also, it is possible that the spectrum of clinical manifestations of pediatric HIV infection in India may differ from the rest of the world. Hence, we conducted this study and compared our findings with some of the studies previously reported from India and other countries.